Shortly after I was diagnosed with a challenging case of prostate cancer in December 1999, I was glad to learn there were some tactics I could employ on my own that would probably help me battle the cancer. The tactics involve nutrition, diet, certain supplements, exercise and stress reduction. Though none of the evidence is completely conclusive at this point, it is still reasonably strong for some of the tactics. I continue to follow developments closely, but I am just a fellow survivor with no enrolled medical education, so use the following for leads and information but not as authoritative medical recommendations.

There is an over abundance of information about such tactics available electronically, much of it good, much of it not. I'm convinced the leading expert in nutrition and lifestyle to aid our battle against prostate cancer is Dr. Charles "Snuffy" Myers, MD, a medical oncologist specializing in prostate cancer who has battled his own challenging case of PC. Dr. Myers has authored or co-authored two books for laymen on this subject: "Beating Prostate Cancer - Hormonal Therapy & Diet," 2006, and, with his wife, a PhD, and sister-in-law, "Eating Your Way to Better Health -
The Prostate Forum Nutrition Guide," 2000. The former book has updated information, including a long discussion of vitamin D and its important role against prostate cancer, as well as information on exercise and stress reduction.

Another good but now somewhat dated book is Dr. Bob Arnot's (MD) "The
Prostate Cancer Protection Plan," 2000 (to which Dr. Myers contributed). While it is now eight years old, most of the information is still worthwhile.

Another helpful book is by Dr. Daniel W. Nixon, MD and Max Gomez, PhD, "The Prostate Health Program - A Guide to Preventing and Controlling Prostate Cancer," 2004.

Dr. Mark Moyad, MD, also has published on nutrition, lifestyle and prostate cancer, but he is quite conservative in his recommendations, wanting to see very solid evidence before recommending something, though sometimes surprisingly taking a flyer without good evidence at all, such as when he recommended flaxseed oil a few years ago, a recommendation he has since reversed. Dr. Moyad is like a conventional doctor who is very knowledgable on nutrition but not at the leading edge. In that sense, what he recommends gives you an idea of where conventional doctors should be if they were to invest the time and devote the attention needed to follow developments.

You can do your own review of scientific research by going to the US
Government web site _www.pubmed.gov_ ([url]http://www.pubmed.gov[/url]) and searching for topics like " lycopene AND prostate cancer ". You'll see evidence for and against each, though my impression is that the trend of evidence is usually fairly clear as you read through the abstracts.

A recent intensive study of the world's medical literature concluded that there were no nutritional elements that conclusively either acted against or promoted prostate cancer, though there were several that "probably" were involved or "possibly" were involved, based on two lesser categories of evidence. That 517 page report is the "World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007." Their expert panel was clearly taking a conservative view, basically setting up a "Good Housekeeping Seal of Approval" type service for nutrition and cancer. The panel found probable benefit from lycopene and selenium foods and selenium supplements as well as possible benefits from legumes, vitamin E foods, and vitamin E supplements. The panel found probable increased risk from high calcium diets and possible increased risk from processed meat and from milk and dairy products. The panel found an unlikely effect on risk from beta carotene food and supplements.

Here's a brief rundown of the most mentioned nutritional items.

Vitamin D3 - most PC patients are deficient in vitamin D, and accumulating evidence suggests vitamin D is very important for success against prostate cancer. The level can be measured with a simple blood test known as 25-hydroxy vitamin D, and the doctors I follow recommend a level between 50 and 80 ng/ml. I gave some detail about this on 02-05-2008, 11:27 AM under the thread "Should we be concerned?" This is particularly important for African Americans because dark skin is so effective in filtering sunlight, which is unfortunately not a good thing regarding vitamin D. Dose recommendations vary, with most doctors I follow recommending between 1,000 to 4,000 units per day, adjusted according to test results, but some recommending up to 8,000 IU per day in order to achieve better test levels. For those who are severly deficient, there is an approved FDA medication that provides 50,000 units. It is possible to overdose, but it is difficult for most of us to do that, and tests to monitor your level ensure that you are in the good range. Before research published in 1999 by Dr. Reinhold Vieth of the University of Toronto, there was a lot of concern about overdosing and a lack of appreciation for the importance of vitamin D, but that has changed a lot over the past decade.

Selenium - 200 mcg per day is the usually recommended dose of this inexpensive supplement. That dose appears quite safe, though there is some preliminary evidence that those with diabetes, insulin resistance or a higher risk of those conditions might be increasing their risk by taking selenium. The recent thread "Cracking the selenium out of Brazil nuts and a safety issue" has further information.

Lycopene - about 30 mg per day is recommended, broken up into several portions a day, and easy sources are tomato or V8 juice and tomato paste (such as in cocktail sauce), and generally stewed or cooked tomatoes.

Vitamin E, especially vitamin E including some gamma tocopherol - 200 IU per day is now recommended. Vitamin E and selenium appear to work together.

Pomegranate juice or extract - a clinical trial by a prestigious team from UCLA demonstrated some remarkable benefits involving patients with recurring prostate cancer patients, who drank high quality pomegranate juice, in clinical trial results published in July 2006. Now an extract is available in capsule form made from the same mix of pomegranate elements that the team researched in the juice. This is exciting research, but the study was funded by the manufacturer of the juice, and it would be reassuring to have a confirming study.

Fish (particularly fatty fish like salmon, herring and sardines) three to four times a week and fish oil, especially for omega 3 fatty acids.

Green tea, especially with a little lemon juice or other source of acid to preserve the potency of green tea's beneficial elements. Two to four cups per day is recommended.

Eating a variety of fruits and vegetables. I'm particularly impressed with claimed benefits from eating broccoli and broccoli sprouts.

Avoiding red meat (including pork), mainly because of a high level of arachidonic acid, which fuels prostate cancer.

Avoid egg yolks.

Avoiding dairy food - milk, cheese, butter, apparently because of the main milk proteing casein, which appears to be a problem for cancer generally and specifically for prostate cancer.

Avoiding flaxseed oil and canola oil, both of which are potent sources of alpha linolenic acid, which aids the growth of prostate cancer cells. Younger women have no problem with these oils, and they appear to help protect against breast cancer and foster cardiovascular health, but they are not a good idea for men, who do not metabolize them well. Olive oil is fine instead of vegetable oil.

Getting aerobic and strength exercise are beneficial, especially 30 - 40 minutes at least three times a week.

Reducing stress, even going as far as meditation, appears helpful.

Taking mild medications like finasteride or Avodart and a statin drug also appears beneficial.

These are most of the main elements. While some of it may seem like the usual pablum - "Take two aspirin, drink plenty of fluids, and stay in bed." - there is good research supporting each of the recommendations.

Thank you so much for this post. We are a family that revolves around nutrition. We eat ground flax seed every day. Does the statement on the flaxseed oil also pertain to ground flax seed?
Thanks

Ground flax seed is really interesting and seems to be different in its impact than flaxseed oil. Ground flax seed does have some alpha linolenic acid, but not very much - not concentrated as it is in the oil. But it also has lignans and some other elements that appear to be helpful to prostate cancer patients. Ground flax seed has been an issue for prostate cancer patients for years, especially from the time some preliminary animal research indicated it might be beneficial.

Dr. Wendy Demark-Wahnefried, leading research from Duke University but now at MD Anderson in Texas, did several studies of ground flax seed and prostate cancer. The last study featured 161 patients, a fairly small trial, randomized to four groups and was carefully done according to a review by Dr. Charles Myers, MD. The impressive main result was a reduction in the tumor proliferation rate.

There is at least a theoretical possibility that cancer progression still took place or was accelerated, despite the reduction in the proliferation rate, as cancer progression was not measured; also, the trial was fairly small and has not yet been published in a respected peer reviewed medical journal. That's why Dr. Myers is witholding a recommendation to use flax seed at this time, though he and a lot of us are hoping the results hold up in follow-up studies.

Abstracts from the earlier published research can be viewed by going to the free Government website [url]www.pubmed.gov[/url] and using this search string: " demark-wahnefried [au] AND prostate cancer AND flaxseed ". The research team has submitted its study to a major journal, but it has not yet been published. (I just checked. I heard a presentation by Dr. Demark-Wahnefried at a conference last fall.) The results are available in abstract from the Spring 2007 meeting of the American Society of Clinical Oncology (ASCO) and perhaps other sources as Dr. Demark-Wahnefried gives presentations about them. Dr. Mark Moyad has also commented on this work.

It's also likely that at least one or a few of the nutritional elements mentioned in the original post may be neutral or even harmful for a few of us, because of the way our genes are expressed, while they are helpful to most of us. For instance, one study suggests that selenium may increase the risk for diabetes for people prone to it, though the evidence for this is fairly weak.) At this point, the research that has been done is just not clear about that for these nutritional elements. Basically we just have to make a decision to use a nutritional element or not, and either way we are taking a chance.

I have decided not to use ground flax seed, though I am tempted. It's a decision each of us must make. If your uncle wanted to start it , he could at least carefully monitor his PSA and see if his rate of PSA increase changed. Of course, it would be impossible to tell the result for sure if he is also changing other dietary and lifestyle practices. If he is already using it, he could try stopping and checking the PSA impact. However, it's hard to be calmly scientific when your PSA is increasing at a rapid clip!

Dr. Demark-Wahnefried does caution patients that the flax seed needs to be fresh, good quality, and properly stored; apparently it can spoil quickly. Perhaps you could comment on that.

My care team have suggested cranberry juice as a good thing to keep the urine flowing after "attention" has been given to the prostate - any comments?

Also I have been unable to track down a supplier of cranberry juice here (though several leads are still to reply) and locals have suggested chokeberry juice as a substitute - again, any comments. What I have learnt of chokeberries (despite a somewhat discouraging name) is: Total anthocyanin content is 1480 mg per 100 g of fresh berries, and proanthocyanidin concentration is 664 mg per 100 g. Both values are among the highest measured in plants to date.

Anthocyanins give chokeberries extraordinary antioxidant strength

Last edited by tumbleweed; 04-12-2008 at 10:40 PM.
Reason: sbstituted common name for scientific name in last line.

my care team have suggested cranberry juice as a good thing to keep the urine flowing after "attention" has been given to the prostate - any comments?

Also I have been unable to track down a supplier of cranberry juice here (though several leads are still to reply) and locals have suggested chokeberry juice as a substitute - again, any comments. What I have learnt of chokeberries (despite a somewhat discouraging name) is: Total anthocyanin content is 1480 mg per 100 g of fresh berries, and proanthocyanidin concentration is 664 mg per 100 g. Both values are among the highest measured in plants to date.

Anthocyanins give chokeberries extraordinary antioxidant strength

Hi,

If you are short of time, the bottom line in answer to your questions is: we don't know enough yet to say much, based on research.

Cranberries and chokeberries have received little attention as nutritional items in support of prostate cancer prevention, active surveillance, or therapy, but there is at least one study relating to symptom control after radiation therapy.

I'm basing this on a few [url]www.pubmed.gov[/url] searches I just did. While cranberry juice has been making the news for years as a possible aid for various urinary problems, I had never heard of it in relation to prostate cancer, and I appreciate your bringing this up.

A search of PubMed for " cranberry AND prostate cancer " resulted in five hits, mostly lab or animal studies rather than studies involving humans, spread out from 2003 to 2006. While an interesting favorable impact was observed in lab studies, the results have not been strong enough to generate a surge in interest compared to what we see with other nutritional items. That doesn't mean there is little value in cranberry juice or extracts of cranberries; it just means that it isn't a headliner yet. The single human trial involved cranberry juice cocktail versus apple juice for side effects of radiation therapy for prostate cancer, and no substantial difference was found.

That could mean that (1) cranberry juice isn't effective, or (2) that cranberry juice is effective but apple juice is just as good, or (3) that the study did not effectively measure the impact. Right off I'm wondering if there was much actual cranberry juice in that "cranberry juice cocktail". The cranberry juice cocktail versions in my local grocery stores often feature high fructose corn syrup as the main element and cranberry juice as a lesser element, making me think there wasn't much in the cocktail. On the other hand, the Canadian center in Vancouver that did the study is known for excellent work, in general.

Regarding the lab studies that showed an impact, that's good, but very preliminary. Most items that are successful in lab or animal studies do not work well in patients. There are obstacles involving survival of the item through the stomach environment, through the intestine, through the liver, and absorption issues. For example, ellagic acid is effective in some non-human studies in controlling prostate cancer, but in actual nutritional items it often fails in humans; however, pomegranates have other elements that apparently enable the ellagic acid to survive and do its good work. For another example, much of the EGCG that appears to be the key anti-cancer element in green tea is destroyed before it can impact prostate and some other cancers; however, research has shown that combining it with a little acid, such as lemon juice, preserves its potency in the body environment. The combination also prevents it from being destroyed by oxidation during brewing.

I got no hits searching for " chokeberry AND prostate cancer ", but got six hits and five hits searching for " Anthocyanins AND prostate cancer " and " proanthocyanidin AND prostate cancer " respectively. One hit in each search overlapped the cranberry search, and the other four hits for proanthocyanidins involved blueberries. I eat a red delicious apple daily, and one of the reasons is that it is an excellent source of proanthocyanidins.

Sometimes formal research moves at the pace of a crippled snail. I'm positive that glucosamine helps me, especially in the knees, but research hasn't been able to show much benefit yet. I also was positive vitamin C helped allergies years before research finally demonstrated a benefit. If you try the cranberries or chokeberries, please pass on your opinion.

I feel that cranberry juice may have helped with my urine flow after biopsy and implantation - in the areas of flow and pain reduction. It could be coincidental of course.

My team certainly felt that cranberry juice was an aid, but were not convinced of pomegranate juice.

I have been relying on pomegranate up til now (as it is all I can get here) but am not convinced it is helping - though as I still have 2 weeks of "getting worse" it is difficult to say how much worse it might have been without it.

I'm not sure how the flow is supposed to be helped - though I have a vague recollection that somewhere along the line it was related to reducing the acidity of he urine and hence the irritation of the distressed urethra (which they call the lumen).